Visuospatial Function Agnosia/Apraxia

Outline
Neuroanatomy Review
retina, LGN, unimodal cortex, multimodal association cortex, parallel processing, What/Where

Disorders of Higher-Order Visual Function

Striate-Peristriate Syndromes Ventral Stream Syndromes Dorsal Stream Syndromes

Assessment of Higher-Order Visual Function

Visuoperception Visuospatial Visuoconstructive

Examples

Neuroanatomy Review

Cortical Brain Regions Involved in Visual Processing

Parietal Lobe

Temporal Lobe

Occipital Lobe

Central Visual Pathways

1 2 3 4 5 6
Adapted from http://thalamus.wustl.edu/course/

Segregation of Dorsal and Ventral Processing Streams

Where Pathway

What Pathway

Classification of Visuoperceptual, Visuospatial, and Visuoconstructive Disorders

Visuoperceptual Visual Object Agnosia Defective visual analysis and synthesis Impariment of facial recognition Impairment in color recognition Visuospatial
Defective localization of points in space Defective judgement of direction and distance Defective topographical orientation Unilateral visual neglect

Visuoconstructive
Defective assembling performance Defective graphomotor performance

Disruption of Visual Information Processing

Vascular lesions Neoplasm Trauma Dementias Toxic/Metabolic Encephalopathy

Peristriate Syndromes
Disorder Blindsight Area of Damage V1 Symptoms Cortically Blind, but may be able to locate objects and avoid obstacles Often have homonymous scotoma Antons Syndrome Akinetopsia Bilateral infarcts to Blind, but denial of blindness PCA territory Bilateral damage to Inability to detect visual motion area MT (O-T) Central Achromatopsia PCA Acquired loss of color perception

Dorsal (Where) Syndromes

Disorder Area of Damage Symptoms Balints Syndrome Bilateral lesions involving cortex and white matter of dorsal O-P areas Ischemic event in posterior watershed areas Hemispatial Neglect Usually after R hemisphere lesion to posterior parietal, frontal eye field, or cingulate cortex Simultanagnosia- inability to recognize a whole image although individual details are recognized Optic Ataxia-difficulty with visually guided movements. Ocular Apraxia- erratic pattern of occulomotor scanning and unpredictable paralysis of fixation during visual search Disruption of spatial representation of contralesional side of space, exploratory scanning, visual extinction, anosagnosia

Ventral (What) Syndromes

Disorder Color Anomia Area of Damage L Occipital lesion w/ R Hemianopia Periventricular white matter. L hemisphere lesion interferes w/ fibers from R O-T areas L O-T region Symptoms Can match, but cannot name colors. Color words retain semantic meanings, but cannot be matched to appropriate visual stimulus Can write, speak, and understand speech, but profound inability to read, even words patient just wrote

Pure Alexia

Object anomia Prosopagnosia

Inability to name objects by sight, can name if other modalities are used. Cannot recognize familiar faces or learn to recognize new ones. Also cannot recognize objects within a specific class (animals, cars, houses, etc)

Bilat infarcts to medial O-T region

Ventral (What) Syndromes

Disorder Area of Damage Symptoms

Associative Visual Object Agnosia

Medial O-T

Visual info cannot activate either verbal of nonverbal associative linkages. Visually inspected objets cannot be named or recognizd by pt with otherwise intact language and perceptual functions Disruption of complex perceptual tasks and maintenance of spatial relationships

Visual integration deficits

Parietal lobe

Peduncular hallucinosis

Central lesionesp in distribution of basilar artery

Formed hallucinations often taking the shape of small animals or people.

Assessment of Higher-Order Visual Function

Why is it important?
Help give information about localization Disruption of visuoperception can influence "downstream" abilities Give recommendations about how to cope with deficits in this area.

Selected Measures of Higher- Order Visual Abilities

Neglect Syndromes Visuoperceptual Visuospatial (mental rotation) Visuoconstructive

Visual Neglect

Raven's Progressive Matrices

Benton Facial Recognition

Gollin Incomplete Figures Test

Hooper Visual Organization Test

Judgement of Line Orientation

Line BisectionTest

Visual Search Tasks

Network Used For Visual Search

Sensory Representation Motor-Exploratory Representation

Posterior Parietal Cortex

Thalamus Striatum

Frontal Cortex

Motivational Representation

Cingulate Cortex

Reticular Structures
Arousal
(Adapted from Mesulam, 1981)

Simultanagnosia

Copy Tasks

Bender Gestalt

Rey Complex Figure

Clock Drawing

Mental Rotation Tasks

Apraxia
Definition: inability to carry out purposive or skills (learned) actions Cannot be due to:
Weakness Akinesia (motor movements) Deafferentation (sensory loss) Abnormal muscle tone/posture Poor comprehension Uncooperative/psychotic patient

Apraxia
Common co-morbid neuropsychological problems:
Aphasia Language disturbance Need to test comprehension (e.g., yes/no questions)

Types of Apraxia
Motor (kinetic) inability to carry out a previously learned motor act using the actual object (e.g., buttoning, opening a letter) Ideomotor inability to carry out an action (e.g., unable to imitate) Ideational pt. attempts to carry out a complex gesture but cannot complete it (can do individual elements, but not sequence) Constructional unable to put together parts to make a whole, usually involves problems with organization as well as construction

Testing for Apraxia

Pantomime show me how you would brush your teeth Imitation of pantomime watch how I would brush my teeth, then you do it Use of actual object here is a hammer, show me how you would use it Imitation of examiner using object watch how I use a hammer, then you do it